Hospital-based Prospective Observational Study Research Articles

Pulse Oximetry Screening for Detecting Critical Congenital Heart Disease in Neonates.

Background Congenital heart disease(CHD) leads to significant morbidity in the neonatal population and is a crucial disorder behind early infancy death rates. Mosthave a critical congenital heart defect (Cr CHD) out of all the heart defects found in babies. A subgroup of cardiac anomalies needssurgery or catheter intervention during the neonatal period. Pulse oximetry is a good screening tool to detect cr CHDin neonates. This study aims to assess the effectiveness of pulse oximetry as a screening toolin a rural setting. Methods This was a hospital-based prospective observational study. All consecutively born neonates whose parents consented to the study were subjected to pulse oximetry on all four limbs. Their peripheral arterial oxygen saturation was measured on days one, two, and three of life, starting four hours after birth. Babies detected with cyanotic congenital heart disease (CCHD) before birth are not a part of this study. All those with arterial oxygen saturation of less than 95% or a difference of saturation of more than 3% in the upper and lower limbs were considered suspects for Cr CHD and subjected to echocardiography. Results Among 5874 neonates studied, researchers found 164 babies to have significant hypoxemia on pulse oximetry, and 44CHD were detected on echocardiography within the first three days of life (positive predictive value (PPV) 12.2%). The physician referred all of them to a higher center before further delay. Thirty-four babies with other congenital heart diseases were found using pulse oximetry examination. Also, 108cases of hypoxemia due to other causes were found and monitored. Conclusion Critical congenital heart diseases are a significant cause of death among neonates and require early diagnosis and emergent medical and surgical management. They are associated with hypoxemia, and this principle can be used to screen them using a pulse oximeter.

Etiological Profiles of Patients With Thrombocytopenia in Central India: A Tertiary Centre Study.

Introduction Platelet-related disease may result from an abnormal platelet count, namely thrombocytopenia or thrombocythemia, or altered platelet function, and thus is associated with bleeding or with thrombotic manifestation. Thrombocytopenia is defined as a subnormal number of platelets i.e. less than 1,50,000/µL in the peripheral blood. It can lead to inadequate clot formation and increased risk of bleeding and is a common indication for bone marrow aspiration and biopsy. Methodology The study was a hospital-based prospective observational study from January 2019 to June 2020. All cases of thrombocytopenia which were diagnosed first on haematology analyser (platelet counts <150,000/µL) and confirmed subsequently by peripheral smear with/without bleeding manifestations due to thrombocytopenia were taken up for the study. The aims and objectives of this study were to find out the epidemiological spectrum and prevalence of thrombocytopenia according to age and sex along with the correlation of haematological and bone marrow findings of such patients. Result This study comprised 100 cases of thrombocytopenia, with acute leukaemia accounting for the majority (28/100), followed by dimorphic anaemia (15/100), megaloblastic anaemia (11/100), hypocellular marrow, infection, and other conditions.All cases (100%) displayed the clinical symptom of widespread weakness and pallor, which was followed by fatiguability (72%) and dyspnoea (48%). Many thrombocytopenic individuals also had lymphadenopathy and hepatomegaly, the last two least common appearances. Lymphadenopathy and hepatomegaly which were the last two least common presentations were present in a significant number of thrombocytopenic patients. Conclusion The study of bone marrow is helpful in the diagnosis of thrombocytopenia cases. Bone marrow examination is a simple, safe outpatient procedure and yields an impressive amount of diagnostically valuable data in a wide variety of disorders of thrombocytopenia.An evaluation of the patient's bone marrow unquestionably aids in the early diagnosis and treatment of their ailment.

Acute Kidney Injury after Endoscopic Retrograde Cholangiopancreatography-A Hospital-Based Prospective Observational Study.

Endoscopic retrograde cholangiopancreatography (ERCP) represents a major pivotal point in gastrointestinal endoscopy. Little is known about acute kidney injury (AKI) post-ERCP. This study analyses the incidence, risk factors, and prognosis of post-ERCP AKI. A total of 396 patients were prospectively studied. AKI was defined by an increase in serum creatinine (SCr) ≥ 0.3 mg/dL or by an increase in SCr ≥ 50% in the first 48 h post-ERCP. Logistic regression analysis was used to identify the predictors of AKI and in-hospital mortality. A two-tailed p value &lt; 0.05 was considered significant. One hundred and three patients (26%) developed post-ERCP AKI. Estimated glomerular filtration rate (adjusted odds ratio (aOR) = 0.95, 95% confidence interval (CI): 0.94-0.96, p &lt; 0.001), nonrenal Charlson Comorbidity Index (Aor = 1.19, 95% CI: 1.05-1.35, p = 0.006), choledocholithiasis (aOR = 4.05, 95% CI: 1.98-8.29, p &lt; 0.001), and bilirubin (aOR = 1.1, 95% CI: 1.05-1.15, p &lt; 0.001) were associated with post-ERCP AKI. Post-ERCP AKI was associated with longer hospital stay (p &lt; 0.001) and with increased in-hospital mortality (7.76% versus 0.36%, p &lt; 0.001). Moderate-to-severe (stage 2 and 3) AKI was independently associated with in-hospital mortality (aOR = 6.43, 95% CI: 1.48-27.88, p &lt; 0.013). Post-ERCP AKI represented an important complication associated with longer hospital stay. Moderate-to-severe post-ERCP AKI was an independent risk factor for in-hospital mortality.

Antibiotics use evaluation among hospitalized adult patients at Jimma Medical Center, southwestern Ethiopia: the way to pave for antimicrobial stewardship

BackgroundAn irrational antibiotic use is a common problem in developing countries like Ethiopia, which makes empiric antibiotics use difficult. It is considered to be the greatest health problem in our time and future unless intervened. Therefore, this study aimed to assess the patterns of antibiotics use among hospitalized adult patients to pave the way for antimicrobial stewardship.MethodsA hospital-based prospective observational study was conducted at Jimma Medical Center, southwestern Ethiopia, from 30 October 2020 to 29 January 2021 with 360 adult hospitalized patients participating. A semi-structured questionnaire and consecutive sampling technique was used for data collection. The data were collected through medical record reviews and patient interviews. The collected data were entered into Epi-data and exported to SPSS® version 23.0 for analysis. Days of therapy (DOT) and essential medicine lists “Access, Watch, and Reserve (AWaRe)” antibiotics classification were used to assess antibiotic use pattern among participants.ResultsThe majority of study participants were females (55.3%), attended formal education (59.4%), and live in rural areas (61.4%) with mean age ± (SD) of 37.65 ± (16.75). The overall rate of antibiotics consumption during the study was 111 days of therapy per 100 bed-days and about two-thirds (66%) of the prescribed antibiotics were from the “Watch” group antibiotics. The indicator level of antibiotics use for “Access” group antibiotics was 34% in this study based on the World Health Organization Essential Medicine List. Cephalosporins were the most commonly used class of antibiotics (93.9%).ConclusionHigher antibiotics exposure and their consumption frequently observed among adult hospitalized patients in the study setting. There was a rapid increase in “Watch” group antibiotics use and about two-thirds of the prescribed antibiotics were from this group. The third-generation cephalosporin were the most commonly used class of antibiotics. Generally, higher consumption and inappropriate antibiotics use among hospitalized adult patients showed the need for urgent interventions by implementing Antimicrobial Stewardship Programs in hospitals.

Potential Clinical Utility of FDG-PET in Non-malignant Pulmonary Disorders: A Pilot Study

Fluorodeoxyglucose (FDG) positron emission tomography (PET) is emerging as an important non- invasive investigation in benign pulmonary conditions too. The aim of this study was to investigate its utility in the diagnosis and monitoring of various benign pulmonary diseases. In this prospective observational hospital-based study 50 consecutive patients (26 males) with benign lung diseases underwent computed tomography of chest followed by FDG-PET at baseline and after treatment where appropriate. The findings of FDG scan are reported in the context of clinical, histopathological, physiological and radiological findings. All patients showed increased FDG uptake in the lung corresponding to CT findings. Of the 9 patients with sarcoidosis stage 1 (n=1), stage 2 (n=3) and stage 3 (n=5), additional uptake in the myocardium and thyroid was noted in two patients which resulted in a change in the modality of treatment. Repeat FDG scan post-treatment showed decreased uptake in all patients which was consistent with clinico-radiologic, microbiological or spirometry findings. Increased uptake was seen in one patient with pulmonary tuberculosis (TB) and in one patient with TB mediastinal lymphadenopathy at the end of intensive phase discordant with clinical and microbiological response. Of nine cases of idiopathic interstitial pneumonias (IIPs), additional intense FDG uptake was found in two cases which corresponded to the areas of honeycombing. FDG-PET scan can be used as an important adjunct non-invasive investigation in diagnosing and monitoring of various benign lung conditions. It also helps in assessing whole body disease burden which may change therapeutic decisions.

Abstract 271: The Time Dependence Of The Effect Of Extracorporeal Cpr For Out-of-hospital Cardiac Arrest Patients

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has been considered as a rescue therapy for refractory cardiac arrest patients. However, little is known about who is refractory to conventional CPR and when to judge the initiation of ECPR. Method: We performed a secondary analysis of the nationwide hospital-based prospective observational study (The JAAM-OHCA registry) in Japan. This study included adult OHCA patients aged ≥18 years who had an initial shockable rhythm between June, 2014 and December, 2019. We classified the included patients into the ECPR group or the conventional CPR group based on whether to receive ECPR or not. Low flow duration (LFD) was defined as the time from call to the initiation of ECPR or to the time of return of spontaneous circulation or termination of resuscitation. The primary outcome was 1-month survival with favorable neurological outcomes defined by cerebral performance category 1 or 2. We visually described the nonlinear relationship between LFD and the predictive probability of favorable neurological outcome using a restricted cubic spline by each group. Results: Of 57,754 patients registered in the JAAM-OHCA registry, 3807 patients were included in analyses (ECPR group, n = 865 and Conventional CPR group, n = 2942). In both groups, shorter LFD was associated with favorable neurological outcome. For first 30 minutes, the overall proportion of favorable neurological was higher in the Conventional CPR group, but due to the rapid decrease in Conventional CPR, it dropped down to almost the same probability before 20 min as that of shortest LFD around 25 min in the ECPR group. After that, the probability of favorable neurological outcome was constantly higher in the ECPR group. Conclusion: The judgement of refractory cardiac arrests and decision for ECPR should be delivered before 20 min from call to maximize the probability of favorable neurological outcome for those with an initial shockable rhythm.

A Study Of Prevalence Of Chronic Kidney Disease In Patients With Metabolic Syndrome In Urban Population Attending A Tertiary Care Center In India: A Hospital-Based Prospective Cross-Sectional Observational Study

The study aims to determine the prevalence of Chronic Kidney Disease (CKD) and its risk factors in patients with Metabolic Syndrome in a tertiary care center in India. It was a hospital-based prospective observational study where NCEP ATP III CRITERIA was used to diagnose patients with Metabolic Syndrome, and CKD was defined according to KDIGO Guidelines. Out of 172 patients with Metabolic Syndrome, CKD was seen in 52 patients, of which 29 were males and 23 were females, so the prevalence of CKD in Metabolic Syndrome patients was about 30.23%. (52/172) P Value = 0.0000204. In our study, the prevalence of hyperglycemia in CKD patients with Metabolic Syndrome was 24.41% (42/172) P Value = .0011. The prevalence of obesity was 19.18% (33/172) P Value = .00844. The prevalence of hypertension was 28.48% (49/172) P Value = 2.72. The prevalence of hypertriglyceridemia was 26.12% (45\172) P Value = 0.000002086. The prevalence of hyperglycemia, obesity, and hypertriglyceridemia was significantly high in males. The prevalence of CKD in Metabolic Syndrome is 30.23% which is quite high, and since the prevalence of CKD is rising in India, we need more studies to look into this aspect of Metabolic Syndrome.

Psycho-social and psychiatric co-morbidity among children with poisoning

Background: The poisoning in children results from exposures to toxic agents that may lead to harmful effects based on the reaction of the body to these agents. Poisoning can be accidental or suicidal in intent. To assess any psycho-social factor that leads to poisoning and to determine any underlying psychiatric co-morbidity among children with acute poisoning.Methods: A hospital-based prospective observational study conducted in postgraduate department of pediatrics, G. B. Pant children’s hospital an associated hospital of government medical college Srinagar Jammu and Kashmir India. This study was conducted over 2 years with effect from November 2019 to November 2021. Psychiatric co-morbidity was determined by using the MINI- KID scale. Results: In our study, 572 cases with poisoning were studied over two years; the mean age of childhood poisoning was 3.8 years. The majority of the poisoning cases were accidental, with male to female ratio of 1.6:1. Most of the cases were seen in lower-middle-class families (65.7%). Organophosphorus was the most common agent involved. Oral ingestion was the predominant route of poisoning. A total of 46 subjects had a psychiatric diagnosis as assessed by MINI-KID. Among which, 34.7% of the subjects had the diagnosis of panic disorder, followed by depressive episodes (MDD) amounting to 26%, and ADHD in 13%. A total of 53 were having underlying psychosocial factors. Adolescent self-poisoning is commonly associated with underlying psychiatric illness.Conclusions: The underlying psychosocial and psychiatric disorders need proper identification and management.

Clinical Profile and Outcomes of Multisystem Inflammatory Syndrome in Children: A Multicentric Observational Study

Background and objectiveMultisystem inflammatory syndrome in children (MIS-C) is a postinfectious, generalized, hyperimmune state and is potentially lethal. There is scarce data on the clinical presentation and epidemiology of MIS-C in India. In light of this, we conducted this study to describe clinical presentations and outcomes in children diagnosed with MIS-C.MethodologyThis was a 15-month hospital-based prospective observational study conducted in the Departments of Pediatrics at Jagannath Hospital and Hitech Medical College, Bhubaneswar. The study included all patients diagnosed with MIS-C and treated at these hospitals between May 1, 2020, and August 31, 2021. The inclusion criteria were as follows: patients who were reverse transcription-polymerase chain reaction (RT-PCR)-positive, antibody-positive, or had known contact with those infected with coronavirus disease 2019 (COVID-19). We reviewed patient medical records to collect demographic data such as age, sex, body mass index (BMI), duration of illness, clinical symptomatology, findings of initial echocardiography, and outcomes. We followed each case for three months. We analyzed descriptive statistics using percentages and means and conducted the statistical analysis using SPSS Statistics for Windows, Version 25.0. (IBM Corp., Armonk, NY).ResultsA total of 30 cases were included in the study, consisting of 16 boys (53.3%) and 14 girls (46.7%). The mean age of the study population was 6.7 years, and 43% had a BMI in the overweight range. All patients (100%) had a fever, 66.7% had lethargy (n=20), and 64.3% (n=19) had abdominal symptoms in the form of vomiting, diarrhea, and abdominal pain. Respiratory distress at admission was found in 16 cases (53.3%), while hypotension at admission was found in 18 (60%) cases. Our population's average duration of pediatric ICU stay was 3.7 ± 1.2 days, and the average duration of inotropy was 2.2 ± 0.5 days. Fifteen cases (50%) required only oxygen support; 10 (33%) required noninvasive ventilation, and only one patient required invasive ventilation. Twenty-two patients (74%) needed fluid boluses. Outcomes of coronary artery dilatations were favorable, regressing to normal (Z-score <2.5) in affected patients within 90 days of follow-up.ConclusionsMIS-C has myriad presenting signs, symptoms, and severity. It is often associated with circulatory failure or shock. However, most patients demonstrated good early outcomes, improved left ventricle (LV) function, normalization of coronary abnormalities, and no mortality. This study provides additional data on the clinical presentation of MIS-C and highlights the importance of close, long-term follow-up monitoring of this patient population.

Management outcome and risk factor in children with severe acute malnutrition in &lt;6 months of age and role of supplementary suckling technique in re-establishing breastfeeding

Aim: The aim of the study was to study management outcomes and risk factors in children with Severe Acute Malnutrition (SAM) &lt;6 months and to assess the role of the Supplementary Suckling Technique (SST) in reestablishing breastfeeding. Materials and Methods: This is a prospective observational hospital-based study done in the Department of Pediatrics in a tertiary teaching institute from October 2019 to September 2020. 75 children who fulfilled the inclusion criteria were included in the study. Children were managed according to the WHO protocol. SST was used to establish breastfeeding in cases of lactation failure. Results: A total of 75 infant’s up to 6 months of age were enrolled. Most infants presented at the age of 2–4 months (42.67%). The male-female ratio was 1.2:1. 50 (66.67%) mothers were illiterate and 65 (82.67%) belonged to the lower socioeconomic status. A history of preterm birth and low birth weight (LBW) was found in 54 (72%) and 62 (82.67%) infants, respectively. Exclusive breast feed was given to 13.33% while top feeding given to 86.6% of infants. With proper management target weight was achieved in 53 (70.66%) infants. Most infants stayed from 11 to 20 days (79.37%). Lactation was re-established in 60.46% of children who tried the supplement suckling technique. Conclusion: Lack of awareness regarding adequate infant feeding practices and illiteracy is an important factor for the high prevalence of malnutrition. SST is an effective way in reestablishing breastfeeding in lactational failure. Proper counseling and education of the mother by health-care professionals can help in improving exclusive breastfeeding rate.

How widespread is Thyroid Disorders among Patients undergoing Coronary Artery Bypass Grafting? A Study from Tertiary Care Hospital

Coronary artery bypass grafting (CABG) is the most commonly performed cardiac procedure and thyroid disorders (hypothyroidism and hyperthyroidism) are the most widespread endocrine diseases. Till date, there is no Indian study pertaining to prevalence of thyroid disorders among subjects undergoing CABG. The aim of this study was to determine the prevalence of thyroid disorders among subjects undergoing CABG in a tertiary care hospital. This is a prospective observational hospital-based study having 560 subjects who underwent CABG. Pre-operative thyroid tests were conducted of all the subjects. On the basis of this test, subjects were divided into groups, “Euthyroid” (normal thyroid status) and Thyroid subjects, that is, Subclinical Hypothyroidism (SCHypo), Overt Hypothyroidism (OVHypo), Subclinical Hyperthyroidism (SCHyper), and Overt Hyperthyroidism (OVHyper), based on thyroid function test. The proportion of the disorders was calculated. The study population included 560 subjects (Males: 457 females: 103). The overall prevalence of thyroid function abnormalities was 41.07%. The SCHypo was the most pervasive thyroid disorder (33.75%), followed by SCHyper (4.28%), OVHypo (2.32%), and OVHyper (0.7%). Highest number of thyroid subject (57.8%) was in 40–59 age group and lowest (0.86%) in 18–39. Thyroid was more prevalent among females (45/103) than in males (185/457). Among subjects undergoing CABG, SCHypo was most common followed by SCHyper, OVHypo, and OVHyper. Among the subjects undergoing CABG, maximum thyroid cases are in the age group of 60–79 with female preponderance.

Assessment of Quality of Life After Ventral Hernia Repair: A Prospective Observational Study at a Tertiary Care Centre.

BackgroundVentral hernias are usually repaired by an open or laparoscopic approach. Quality of life after ventral hernia repair is a very important but often underestimated parameter. This prospective observational study was conducted to assess the quality of life and other related parameters after all types of ventral hernia repair, mainly between open and laparoscopic repairs. ObjectivesThis study aimed to determine the quality of life after ventral hernia repairs. We also analysed and compared various parameters such as outcomes and satisfaction, postoperative pain, and complications between laparoscopic and open ventral hernia repair. MethodsThis was a hospital-based prospective observational study conducted from January 2020 to December 2021, which included a total of 70 patients with ventral hernias. Thirty-nine patients underwent open repair and 31 patients underwent laparoscopic repair. Demographic data and other data such as postoperative hospital stay, return to activity, postoperative pain, complications, and quality of life were collected and analysed.ResultsThe distribution of different types of hernias observed in our study included 34% incisional hernias, 33% umbilical and paraumbilical hernias, and 33% epigastric hernias. The incidence of complications was significantly less in laparoscopic repair compared to open repair. Also, satisfaction at 1 month was significantly more in the laparoscopic group compared to the open group. However, there is no significant difference in the postoperative pain, postoperative hospital stay, return to activity, satisfaction at discharge, and quality of life at 1 month in both the laparoscopic and open repairs. ConclusionLaparoscopic ventral hernia repairs are associated with lesser complications and higher satisfaction. The use of tackers and trans-fascial sutures can significantly increase postoperative pain in laparoscopic repair and is the major factor affecting the short-term quality of life in laparoscopic repairs. As there is no difference in postoperative pain, hospital stay, and return to activity, laparoscopic repairs should be preferred wherever possible in view of fewer complications and higher satisfaction.

A Comparative Study of Neonatal Outcome in Early-Term Neonates versus Full-Term Neonates in a Tertiary Care Hospital in North India

Background: Neonatal morbidity due to physiologic immaturity has been extensively studied in preterm infants delivered in less than 37 weeks gestation. However, evidence indicates that the infants delivered between 37+0 and 38+6 weeks gestation are also at increased risk for morbidity compared with the infants delivered at 39+0 to 40+6 weeks. Methodology: The present hospital-based prospective observational study was conducted among 150 neonates [75 babies each of early term (37+0 to 38+6 weeks) and full term (39+0 to 40+6 weeks)], born to consenting mothers in a tertiary care referral and teaching hospital, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly. Apart from maternal demographic and obstetric factors, features of the newborn - APGAR score at 1 &amp; 5 minutes, admission to NICU, and other morbidity indicators such as respiratory distress, hyperbilirubinemia, neonatal sepsis, and prolonged hospital stay (&gt;7 days), etc were recorded and compared. SPSS v21.0 was used for statistical analysis. Results: The mean age of mothers was 25.27+3.93 years (age range 19-40 years). Early term deliveries were common among older age groups, and full term among younger ones. Full term neonates had a higher APGAR 1-minute score than early term (p = 0.049), but this difference was not significant at 5-minute score (p &gt; 0.05). NICU admission, respiratory distress and jaundice were more common among early term as compared to full term neonates (*p &lt; 0.05). Conclusion: Early term neonates have a significantly higher morbidity and distress as compared to full term neonates. Studies are recommended to develop strategies to reduce early delivery of high-risk pregnancies.

Drug therapy problems and predicting factors among ambulatory epileptic patients in Jimma Medical Center, Southwest Ethiopia.

BackgroundThe care of epileptic patients is complicated by the cognitive adverse effect of the drug, disease, pharmacokinetics, and pharmacodynamics properties of antiepileptic drugs which in turn intensify the risk of drug therapy problems among epileptic patients.ObjectiveTo assess drug therapy problems and predicting factors among ambulatory epileptic patients at Jimma University Medical Center, Southwest Ethiopia, from September 2020 to May 2021.MethodologyA hospital-based prospective observational study was conducted. A semi-structured questionnaire was used to collect data from patients as well as from charts. Drug therapy problems were identified using Cipolle’s, Morley, and Strand drug therapy problem identification and classification method. Data were entered into Epi data manager version 4.6 and exported to statistical software package for social science version 23.0 for analysis. Multiplestepwise backward logistic regression analysis was carried out to identify predictors of drug therapy problems. The 95% CI was used to show an association between the dependent and independent variables. P-value < 0.05 was considered as statistically significant.ResultsOf the total 320 epileptic patients 224(70.0%) patients had at least one drug therapy problem. A total of 395 drug therapy problems were identified among two hundred twenty-four patients with an average of 1.2 drug therapy problems per patient. The frequently identified drug therapy problems were non-compliance 115(29.11), adverse drug reaction 110(27.84%), and dose too low 103(26%). Getting of a drug by purchasing [AOR = 4.6,95%CI:(2.05–10.7)], poorly involvement of the patients in therapeutic decision making [AOR = 3.02,95%CI:(1.5–6.06)], the number of medications ≥ two [AOR = 5.3,95%CI:(1.2–22.9)] and having had uncontrolled seizure [AOR = 10.9,95%CI:(4.9–24.2)] were independent predictors of drug therapy problems.ConclusionsDrug therapy problems were common among epileptic patients in the study area. Patients who were getting their drugs by purchasing, poorly involved in therapeutic decision making, having had an uncontrolled seizure, and taking two and above drugs were more likely to experience drug therapy problems. Therefore, due attention should be given to patients with the aforementioned problems to decrease the occurrence of drug therapy problems and improve overall outcomes among epileptic patients.

The Study of Associations of ECG Changes in Lead aVR and Lead V6 with Acute Coronary Syndrome (ACS)

BACKGROUND&#x0D; The ECG (Electrocardiogram) lead aVR gives reciprocal data for the aVL, II, V5, and V6 leads. It is frequently ignored, even while reviewing complicated ECGs. The purpose of the study was to evaluate the associations of ECG changes in Lead aVR and Lead V6 with acute coronary syndrome (ACS) and coronary complexity as measured by CAG (coronary angiography) in patients with the ACS.&#x0D; METHODS&#x0D; This was a prospective Hospital-based observational study. A sample size of 80 patients was being used and a study was done on patients admitted to Mahatma Gandhi Medical College &amp; Hospital, Jaipur with ACS, for 18 months, as well as on those who met the inclusion criteria.&#x0D; RESULTS&#x0D; Of 80 patients enrolled with ACS, the mean age was 60.3500 ± 14.8717 (Mean ± SD). The proportion of patients (72.5 percent) had a history of hypertension, and the prevalence of diabetes in the population was found to be significant. The mean ST elevation in lead aVR of patients was 1.4500 ± 0.6779. The mean ST depression in Lead V6 (Mean ± SD) of patients was 2.1519 ± 0.6063. The mean ST depression in corresponding leads (Mean ± SD) was 2.0375± 0.6303 in patients of ACS. In CAG, 27 (33.8 %) patients had TVD (triple vessel disease), 20 (25.0 %) had DVD (double vessel disease) and 22 (27.5 %) patients had SVD (single-vessel disease). The majority of patients, 46 (57.5 %) had angioplasty, and the distribution of coronary artery bypass graft (CABG) outcomes in the overall population was determined to be significant. ECG changes in leads aVR and V6 correlate with age, lead V1, corresponding leads, troponin levels, and Timi Score (Thrombolysis in Myocardial Infarction). There is a positive association in both leads aVR and V6, and the changes occur concurrently in terms of many parameters, indicating the necessity for additional investigation. The outcomes of our investigation were consistent with the findings of ST-T changes in lead aVR and lead V6.&#x0D; CONCLUSIONS&#x0D; ECG changes in leads aVR and V6 are associated with poorer prognosis in ACS. Widespread ST-segment depression and ST-segment elevation in lead aVR during episodes of chest pain may represent diffuse subendocardial ischemia caused by severe coronary artery disease (CAD). Further, when interpreting the 12-lead ECG in clinical practice, physicians should give due consideration to the tracing of lead aVR and lead V6 as it can help in identifying the patients who need more aggressive management.

Impact of Pregnancy on Susceptibility and Severity of COVID-19: A Hospital-Based Prospective Observational Study.

Objective: Pregnancy is a transient state of immunosuppression. The objective of this study was to ascertain whether pregnant women are more susceptible to coronavirus disease 2019 (COVID-19) than non-pregnant women and the impact of pregnancy on the severity of COVID-19 and associated morbidity and mortality.Methods: A prospective observational study was performed at All India Institute of Medical Sciences (AIIMS) Rishikesh for a period of two months. A total of 42 and 33 COVID-19 positive women were included in the obstetric and non-obstetric cohorts respectively.Results: Baseline characteristics were similar in both groups. Approximately 48% of the obstetric cohort had no COVID-19-related symptoms. Whereas, 100% of the non-obstetric cohort was symptomatic and had a significantly higher number of patients presenting with fever, cough, and breathlessness. The obstetric cohort had a significantly higher incidence of mild disease (p=0.009). In the obstetric cohort, the mean gestational age was 32.59 ± 2.57 weeks, with patients spread across all trimesters. Most of the patients with severe disease were in their second trimester. There was no difference in intensive care unit (ICU) admission, duration of ICU stay, duration of hospital stay, and mortality among both groups. A significantly smaller number of patients in the obstetric cohort required ventilatory support (p=0.0002). The maternal mortality rate was 16.67%. All of them had severe diseases requiring ICU admission. The cause of death was attributed to severe COVID pneumonia with septic shock in all cases. The mortality rate was comparatively higher (27.27%) in the non-obstetric group.Conclusion: Pregnancy, unlike other immunocompromised conditions, does not seem to affect the prognosis of COVID-19 in terms of disease severity or mortality.

Functional outcome of unstable pelvic fractures treated in a level III hospital in a developing country: a 10-year prospective observational study

BackgroundUnstable pelvic fractures are severe and life-threatening injuries with high morbi-mortality rates. Management of these fractures is a major challenge in orthopaedic practice in limited resource communities. The aim of this study is to evaluate the functional outcome of unstable pelvic fractures managed in a hospital with limited diagnostic and therapeutic facilities.MethodologyThis was a hospital-based prospective observational study carried out from 1st of January 2009 to 31st of December 2018 at the Limbe Regional Hospital, a level III health institution in the South-West region of Cameroon.ResultsA total of 68 patients were included in the study. The ages ranged from 18 to 80 years with a mean age of 39 ± 5 years. The average follow-up duration at the latest visit was 36 months (range 3–84 months). There were 59 cases that were evaluated. The overall average Majeed score was fair. Poor outcomes were noted in patients aged 60 years and above, those with co-morbidities, and those managed conservatively.ConclusionAlthough the functional outcomes following unstable pelvic fractures have improved with modernised diagnostic and therapeutic modalities, it is not the case in poor resource settings where the lack of these modalities makes the management challenging, consequently affecting the functional outcome.

Acute Anterior Wall Myocardial Infarction

Background: According to recent research, examining the ST-segment shift in lead aVR provides valuable information on coronary angiographic anatomy and risk categorization. In acute anterior wall myocardial infarction (MI), lead aVR has diagnostic and prognostic relevance. The purpose of this study is to look at the relationship between presenting clinical status and coronary artery disease risk factors and ST-segment deviation in lead aVR. Methods: This prospective observational hospital-based study was carried out in the Department of Cardiology at Batra Hospital and Medical Research Centre in New Delhi. Patients with acute anterior wall ST-elevation MI who presented within 24 h of symptoms were included in the study. Continuous data were expressed as mean standard deviation and categorical variables as the number or percentage of patients. Results: The study involved 73 individuals who met the inclusion and exclusion criteria and had acute anterior wall ST-elevation MI. Thirty of the 73 patients (41%) had ST-segment elevation in lead aVR larger than 0.5 mm. In two groups, the distribution of various cardiovascular risk factors was examined. In all of the cases, the left anterior descending artery was affected. Patients with double- and triple-vessel disease were seen in more significant numbers in Group A than in Group B. Cardiogenic shock occurred in 6 of 30 patients in Group A and 3 of 43 patients in Group B. Conclusions: ST-elevation in lead aVR has predictive value. Patients with higher ST-segment elevation in aVR are more likely to suffer angina, CHF, and cardiogenic shock complications. Providing these patients with percutaneous or surgical revascularization therapy as soon as possible can reduce mortality.

Sensorineural hearing loss and ulcerative colitis in remission.

Sensorineural hearing loss (SNHL) has been reported in association with inflammatory bowel disease (IBD). However, SNHL as an extraintestinal manifestation of IBD is frequently underreported. In the present study, we compared the prevalence and severity of SNHL among patients with IBD-ulcerative colitis (IBD-UC) in remission with controls to find out any association between SNHL and IBD-UC in remission compared to controls. This single-center hospital-based prospective observational study included outdoor patients with IBD-UC in remission and healthy age- and sex-matched controls. Eligible patients and healthy participants were subjected to a battery of audiological tests (otoscopy, tympanometry and pure tone audiometry [PTN]) after thorough systemic and ear, nose and throat (ENT) examination. A total of 100 patients were enrolled in the study: 50 in IBD-UC in the remission group and 50 in the control group. None of the demographic variables (age, gender, residence and habits) were significantly different between the two groups. Otoscopy and tympanometry were normal in all patients and controls. The difference between the two groups in respect to frequency and severity of SNHL onPTA and in respect to unilateral and bilateral distribution of the hearing loss was not statistically significant. There is no statistically significant difference in frequency and severity of SNHL between patients with ulcerative colitis in remission and healthy age- and sex-matched controls.

Various Options for Scrotal Reconstruction: A Prospective Observational Study.

BackgroundScrotal defects in developing countries are common challenges for the reconstructive surgeon and hence this work has been done with the aim to compare the outcome, advantages and disadvantages of different modalities of scrotal reconstruction.MethodsThe prospective observational hospital-based study of reconstruction of scrotal defects following trauma and Fournier’s gangrene was done over a period of three years. Scrotal defect reconstruction was done in 35 patients by scrotal advancement flap, split thickness skin grafting, medial thigh flap, anterolateral thigh flap and groin flap keeping in mind the various indication of different modalities. The reconstructed scrotums were observed for flap survival and skin graft intake for seven to 10 days in the hospital and then were followed for three months in a follow-up clinic.Results and observationsThe mean age of our patients was 48.57±5.01 years. Most of the soft tissue defects of the scrotum were post-traumatic (83%). Scrotal reconstruction was done often by flaps and more frequently used flap for reconstruction of scrotum was scrotal advancement flap. All flaps and grafts survived well. Mean hospitalization time was highest for groin flap cover whereas mean operative time was highest for anterolateral thigh flap cover.ConclusionEvery case of scrotal defect needs an individual approach for scrotal reconstruction depending upon patient age, general condition of the patient, wound status, and the patient’s requirement.